Annual Report Fiscal Year 2021:

This section provides a summary of FFY21 activities, accomplishments, and challenges related to NPMs and State Performance Measure (SPM)s (2021-2025) for the Perinatal/Infant Domain.

While Wyoming mothers report higher than national average in placing babies to sleep on their backs, the Wyoming PRAMS data indicates that improvements could be made in the areas of placing babies on a separate, approved surface and making sure babies are placed without soft objects or loose bedding. In 2020, about half of mothers (49.5%) in Wyoming reported that in the past two weeks their infant usually slept with a blanket; just under one third (29.6%) reported their infants usually slept on a twin or larger mattress or bed; 11.1% reported their infant slept with crib bumper pads; 10.7% reported their infant usually slept on a couch, sofa, or armchair; and 7.6% of women reported their infant usually slept with toys, cushions, or pillows.

Strategy 1

Utilize PRAMS data to identify disparities in safe sleep practices for Wyoming families that use the home visitation program. Offer provider training on safe sleep using a health equity lens.

PRAMS data can help identify where disparities may exist across maternal age, income, education, and marital status. More analysis would be required to further stratify by PRAMS respondents who also reported participating in home visiting. Additionally, due to lack of WY MCH and Epi staff capacity, and Wyoming Hand in Hand Home Visiting Program data not yet being available, disparities in safe sleep practices of Wyoming families that use the home visitation programs were not identified during this time. Thus, education and resources were not developed or provided to families that may implement safe sleep practices less often or as part of the general home visitation model and schedule of visits. Additionally, education and resources were not provided to PHN and providers outside of the training the PHNs received as part of the home visiting program.

In the summer of 2021, the PHN home visiting program, Wyoming Hand in Hand, started using the evidence-based, Australian MECSH model. This curriculum provides information and best practices on safe sleep and sudden infant death syndrome (SIDS) prevention for enrolled mothers, beginning in the prenatal visits and continuing as part of each visit up until the infant is 26 weeks.

To gather a better understanding of safe sleep in Wyoming, in January 2021, a RFP to conduct virtual focus groups was released. In summer of 2021, the OMNI Institute was selected to conduct these virtual focus groups throughout Wyoming, in both English and Spanish, to better understand the knowledge of, and barriers to, safe sleep practices. The OMNI Institute completed this work in April 2022.

Strategy 2

Promote importance of smoking cessation among women of reproductive age and pregnant women, and implement evidence-based activities to address barriers to smoking cessation

In FFY21, the WIHP addressed smoking cessation among women of reproductive age and pregnant and postpartum people by continuing to fund and support the Wyoming Hand in Hand Home Visiting Program. As part of this program, PHNs are required to talk to participating mothers about their smoking status and ultimately refer them to the Wyoming Quit Tobacco Program (WQTP). WQTP is a smoking cessation program that serves Wyoming residents and is managed by the WDH TPCP. WQTP has a specific Pregnancy and Postpartum Program, which has specialized counseling for pregnant and postpartum people, as well as different incentives compared to the program for the general population of Wyoming (e.g., prepaid gift cards of $10 for every counseling call completed while pregnant and $20 for every call completed in the postpartum period).

In FFY21, The WIHP continued to promote the WQTP through distribution of marketing materials in PHN home visiting and PHN offices. These marketing materials, directed at both the general population who smoke and people who are pregnant and smoke, included Quitkits and brochures on smoking cessation in both English and Spanish. In spring 2021, a number of PHN offices requested refill Quitkits that they could give to clients or those who visited their offices. Those kits were ordered in spring 2021 but were not delivered until February of 2022 due to delays in printing and staff turnover.

Additional Strategies:

Fetal Infant Mortality Review

WY MCH held several meetings with county and state level partners to determine if Fetal and Infant Mortality Review (FIMR) should be conducted at the state or county level. Implementation may begin during the five-year cycle.

Due to low WY MCH staff capacity and increased focus on establishing a MMRC, efforts in FFY21 to establish a FIMR at the state or local level have been put on hold. Training materials developed from the last FIMR (led by WY MCH and community partners in Fremont County, Wyoming) will remain available to train future FIMR members, if it is reintroduced in Wyoming.

Plan of Safe Care

As of FFY21, Wyoming does not currently have a Plan of Safe Care (PoSC) in place and needs to comply with this federal mandate issued under the Child Abuse and Prevention Treatment Act/Comprehensive Addiction and Recovery Act (CAPTA/CARA). The WIHP manager sits on a PoSC working group (comprised of PHN staff, DFS staff, and a nurse champion) that has utilized partnerships with the Association of State and Territorial Health Officials OMNI Learning Community and the Utah AIM Opioid Use Disorder safety bundle to not only understand what other states have done to roll out this policy, but to educate providers and nursing staff about Wyoming mandatory reporting laws, CAPTA/CARA laws, and what Wyoming hopes to achieve from this plan.

The PoSC working group has sought federal in-depth technical assistance with the National Center on Substance Abuse and Child Welfare, through a joint application from WDH and DFS. During the drafting of the federal application, the working group lead and the federal lead presented to the WyPQC. The WIHP manager facilitated the presentation and saw many great questions come through from WyPQC members. This presentation created further statewide buy-in and interest in an alternative to ensure birthing people can receive the assistance they need, and that the rate of infants placed in foster care decreases in Wyoming. PHN is also participating in PoSC community meetings and related training.

Annual Report Fiscal Year 2021 Supplement:

This section provides an interim update for FFY22 activities currently in process for the WIHP.

Safe Sleep Promotion

Ongoing efforts to increase safe sleep have included focus groups to better understand knowledge and barriers to practicing safe sleep, and collaborations with county PHN to disseminate safe sleep books to new mothers in their respective counties. The OMNI Institute conducted focus groups, analyzed results, and provided a final report in spring 2022. These results will help to inform future programming efforts targeting safe sleep. The WIHP purchased multiple orders of Charlie’s Kids Sleep Baby Safe and Snug safe sleep children’s books for interested Wyoming PHN offices to distribute to new mothers as part of an engagement incentive to enroll in the Wyoming Hand in Hand Home Visiting Program. These books will be mailed to counties in summer 2022.

Smoking Cessation

Ongoing efforts to increase smoking cessation among pregnant and postpartum people have included mailing Quitkits and smoking cessation brochures to counties who have previously requested more Quitkits in FFY21. These Quitkits were mailed out in spring 2022. Collaboration with the Wyoming Department of Health’s Community Prevention Unit is being explored. Projects on which to partner are being brainstormed and will hopefully be implemented in FFY23.

FIMR

Prior to the current reporting period, FIMR activities were conducted in one Wyoming County (Fremont). During this reporting period, outreach to stakeholders occurred; however efforts were paused due to turnover in staff and efforts to establish the UT-WY MMRC. Currently, WY MCH is in the process of reviewing the FIMR manual, looking at other states’ models, exploring feasibility, and evaluating required resources to re-establish FIMR in Wyoming. Past experiences in Fremont County FIMR, and any lessons learned from the joint UT-WY MMRC, will be incorporated into this ongoing assessment and exploration.

Plans of Safe Care

The work on PoSC continues into FFY22. While the WIHP manager is not leading PoSC efforts (it is led by DFS), the WIHP manager is a member of the PoSC leadership committee. Currently the WyPQC QI Initiative is to improve substance use screening and referral at hospitals. As this project is extremely related to PoSC work, talks this year have evolved into the idea of a joint WyPQC and PoSC initiative. With both groups coming together to improve screening and referral for substance use at hospitals, the initiative has a greater chance of creating a sustainable and long lasting positive impact.